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Influenza pandemic

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A framework for thinking about flu pandemic and OSAT[edit]

A flu pandemic is many people ill at the same time, and some die.

3 things to do:

  • It's obvious we'll need to take care of the sick. And also the dead, the orphans, etc.
  • If the sick are many or severe, we'll want to reduce the sudden flow, by reducing infections upstream.
  • Both the disease itself and our actions to reduce it have the potential to cause systemic mess, and we want to cope with that.

So it's Treat, Prevent and Cope:

  • All at the same time, but Prevent, particularly in the case of school closure, has to happen soon enough.
  • Treat needs are higher at the peak.
  • And Cope needs are high at the onset when there's the potential for disproportionate disruption, and as things evolve and become messier.

Many people all over the world. How do we do that for/with many?

  • Treat: antivirals, statins, antibiotics, good home care, cellphone networks to ask for advice and move those who can benefit from a higher level of attention. And lots of information on what-works and what-doesn't.
  • Prevent: simple washable masks, knowledge and ideas about ways to do stuff without getting close to each other, good-neighbour behaviour to shop for each other when sick so you don't contaminate the supermarket I go to, and of course school closure made practical. And maybe fast high-yield vaccines, but that's not in our hands.
  • Cope: Appropedia. Cell-phone crank-chargers coupled with militarised comm-tower maintenance, internet applications to help people collaborate with physical neighbours, and maybe some other things. Real "thinking".

Some hard facts[edit]

History[edit]

There have been roughly 10 pandemics of influenza in 300 years, at 10-50 year intervals, which is why the World Health Organisation (WHO) says "when, not if". We don't know when or from which virus, how severe for individual people or how contagious among human populations, but the world is acting on the assumption that there will be a pandemic.

A large factor of worldwide flu occurrence in the 20th century was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease quickly to communities worldwide. Travel of large numbers of troops combined with government censorship (due to their attempts to keep morale up) were major factors during World War 1.

After World War 1 there was still widespread ignorance in the population about influenza, a generally poorer response than we could manage today, poorer communications (especially with censorship in the originating countries in wartorn Europe), less comprehensive health care systems, and no antibiotics to treat the bacteria that infected lungs weakened by influenza.

It seems possible that it did not strike as quickly as sometimes reported - that there were symptoms, but they weren't recognized quickly. But that's not something to take for granted. If we do face a disease that strikes as quickly as this (as does Ebola), much more drastic action, with severe travel restrictions, will be needed. The biggest worry would be something as severe as that, but with a longer incubation period, so it could go undetected and spread widely before being detected - this of course is what makes HIV so insidious.

H5N1[edit]

The influenza virus A(H5N1) (H5N1 for short) gives us specific reasons to worry:

  • like any other flu virus, it keeps mutating and exchanging pieces of genetic material with other influenza viruses.
  • so far, it has caused disease in more than 300 people, and killed more than half of them (see here).
  • it disproportionately targets the young.
  • each human case (detected or not) means one more chance for it to go pandemic.

And yet, we don't know if the next pandemic will be caused by:

  • a mutated H5N1.
  • H5N1 reassorted with another virus, yielding HxNy.
  • another virus, say H7Nx or whatever.

Stoppable?[edit]

Acording to WHO, detected instances of a pandemic virus would be stoppable if detected soon and happening in a rural environment. Not enough at all when you consider that more than half of human population lives in urban environments, with many in overcrowded conditions. So we must get ready for what comes after failure of initial containment.

How bad is "bad"?[edit]

In 1918-19, case-fatality-rate (the number of deaths among those who fall ill) was 2-6%. If the next pandemic is caused by a mutated H5N1, it could be higher, and perhaps much higher.

Even a 2% lethality pandemic (one which infects maybe 30% of human population in 2 or 3 waves (each 5 to 10 weeks long), and kills 2% of those ill) is said to be able to bring much of globalisation to a halt, or at least we'd be in for a long bad ride. Pandemics last for one year or more, vaccines would be available for a few people starting 6 months after the begining.

It has been said that we're now at the same stage as hours before Hurricane Katrina|Katrina]]: it might take more or less time or it might even fizzle out but we'd better get ready.


Influenza complications[edit]

Usually arise from bacterial infections of the lower respiratory tract. Signs of a secondary respiratory infection often appear just as the victim seems to be recovering. These signs include high fever, intense chills, chest pains associated with breathing, and a productive cough with thick yellowish green sputum. If these symptoms appear, medical treatment is necessary. Other secondary infections, such as sinus or ear infections, may also require medical intervention. Heart and lung problems, and other chronic diseases, can be aggravated by influenza, which is a particular concern with elderly patients.

Some good news[edit]

Vaccines?[edit]

Right now, flu vaccines are made each year for a small number of people in a small number of countries, and it takes 6 months or more once they have the virus. This wouldn't be enough in a pandemic.

There are yet-to-be-accepted vaccine technologies that could yield lots of vaccine in a couple of months. As is the case with any other pharmaceutical product, they could potentially do more harm than good and they are not easy to distribute. And we'd still have the problem of getting through those first months, all over the world, so we still have a huge problem even in the best worst case, if you know what I mean.

Distance![edit]

We know distance works if applied soon. The peak in each wave can (and should) be delayed, and the curve can (and should) be made flatter, so that resources (health care and societal) aren't so much overwhelmed.

That's why under all but the lightest scenarios the US, and likely many other countries, are planning to close schools (all schools and universities etc) as soon as there's a confirmed human cluster of laboratory confirmed pandemic flu. They also plan to keep schools closed for 4-12 weeks and, if it's deadly enough, keep children out of the streets as much as possible.

This will mean a "siesta", or death, for the tourist sector all over the world. Are you ready?

People will have to use their creativity to redesign daily activities in order to keep the 3-6 foot rule: stay away from each other. This will mean bringing work home, staggering transport timing, doing the 3 family tribe trick or variations (2 parents care for 6 children in the larger home, while 4 parents go to work from the medium-sized home, and the smaller home stays available for Woodson's Good Home Care of Pandemic Influenza), etc.

All of this, applied in an *early* (you don't wait to put off a fire), targeted (focus on the most respiratory promiscuous, then on the next most, etc), layered way (like layers of swiss cheese, each with holes but non-congruent holes) would reduce infection rates even for those who do go out.

Recently the US has put out a document with very general guidance for other countries.

Masks?[edit]

We know masks are not perfect but are to be used as an addition, not a substitute, for distance. And there's appropriate tech regarding masks: http://www.fluwikie.com/pmwiki.php?n=Brainstorming.SimpleMasks (you can also google for "site:newfluwiki2.com simplemasks urdar" and/or look for urdar's diaries - he's been working on that and has information on what kind of stuff would be best for home-made, washable masks). Masks need to have a good fit etc, or otherwise they are counter-productive, just as pierced condoms provide a false sense of security to hormone-blinded teenagers.

Physical measures?[edit]

Another thing to think about: physical measures on the air around us. There's a paper describing an animal model in which guinea pigs catch the flu much less if the air is warm (as in 30ºC) and humid (as in "quite uncomfortable"). Of course, this doesn't mean you want to be in population-dense Calcutta - again, there needs to be distance for anything to work, and physical measures are an extra layer. There's also a paper from 1957 describing how UV light reduced transmission a lot in a very specific setting.[verification needed]

What to do[edit]

Learn[edit]

Prepare[edit]

Stock up[edit]

"EVERY Australian household should stockpile at least 10 weeks' worth of food rations to prepare for a deadly flu pandemic, a panel of leading nutritionists has warned." -- Stockpile food for flu crisis, Courier Mail, December 16, 2007

The world is arguably not in a position to stock up massively at all. First responders and worldchangers do have a reason to stock up on some food (probably starting with US recommendation for 2 weeks of food, water and OTC medicines as per Woodson's guidance, and also essentials like insulin if someone is dependent on daily doses) and lots of knowledge (and more to be found in http://www.fluwikie.com), plus ideas and networking (both personal and wireless/resilient/whatever).

Help with appropriate technology![edit]

NOT THIS: there's DIY tech for http://blog.makezine.com/archive/2007/12/pandemic_ventilator_proje.html but I'd rather not have to use one of those, and would there be electricity and healthy people around to operate it? We should focus on the many, not on the few.

BETTER THIS: focus on Simple masks, collecting links of things that would be useful in a pandemic, and maybe develop specific stuff or ways to replicate good stuff in a rush ...

See also[edit]

Interwiki links[edit]